Mentalization: Understanding Misunderstanding
It’s a Monday morning and your preteen child is lying in bed, despite your repeated efforts to rouse them. The school bus is due to arrive in 15 minutes. At last, your child shuffles towards the bathroom, walking right past you in the hallway without making eye contact. They head into the bathroom and slam the door shut loudly.
Why do you think your child is behaving this way?
How do you think they might be feeling?
And why do you think they might be feeling that way?
The process of imagining the thoughts, feelings, desires, beliefs, and other mental states that underlie behavior is called mentalization. This common, often taken for granted process contextualizes behavior and gives it meaning. It is essential for managing our thoughts and feelings, effectively responding to our own and others’ experiences, maintaining satisfying relationships, and stabilizing our identity. Although human beings have evolved to have the capacity to mentalize, it is a capacity that must be developed within relationships. The accuracy, consistency, flexibility, and general tendencies with which we mentalize have a great deal of bearing on our psychological and personality functioning (Choi- Kain & Unruh, 2016).
So, what does robust, flexible mentalization look like exactly?
If you were effectively mentalizing in the situation above, you might have inferred that your child was feeling tired. You might have wondered if their tiredness might have caused them to be groggy or grumpy, and this might have accounted for why they looked right past you in the hallway and slammed the door shut. You might find yourself wondering about why they might be so tired this morning. It’s likely that you would then respond to them in a way that somehow acknowledged their tiredness and possibly offered support or structure that could help them get out the door on time. All of this would be very easy for you to imagine as you read the paragraph above, in no small part because you are reading about this fictitious situation from a safe remove, most likely in a state of low emotional arousal.
However, it’s easy to imagine how, if the situation were happening to you in real time, you might experience the same situation quite differently. You might feel frustrated and encumbered in your own morning routine by having to divert your energy and attention to helping your child get out of bed and to the bus on time. You might take their failure to respond to you as a sign that they don’t respect you. You might even think that they don’t care about you at all. You might think that they’re irresponsible, bad at time management, or simply don’t care about rules and routines. It is likely that your response to your child would be quite different in this scenario.
Imagine further, how your relationship with your child over time might change if you were to consistently have difficulty in mentalizing them effectively and accurately. Imagine also how your perception of yourself as a parent or as a person might shift with these repeated difficulties. If you, as a parent, had consistent difficulties with mentalizing, imagine how your child’s own ability to imagine mental states flexibly and accurately might also be affected. In addition, their own self-understanding, ability to manage thoughts and feelings, and ability to relate to others could be affected as well.
While we are all prone to mentalizing difficulty from time to time, some of us are more likely to lose this ability and/or are slower to regain it once it is lost. Mentalizing is most likely to be affected by emotional arousal and attachment activation.
How do we foster better mentalizing in psychotherapy?
Let’s imagine that you have a session with your therapist following the difficulty with your child and imagine how they might assist you in regaining your ability to mentalize.
The techniques in Mentalization-Based Treatment (MBT) are relatively straightforward and simple. One technique that a therapist might use is to rewind a narrative to an earlier time when mentalizing was more intact, restore mentalization, and then re-explore the more difficult emotionally-charged point of the narrative. They might also use empathic validation as they do this.
An important tool for stimulating mentalizing in MBT is the assumption of a “not knowing” stance. Your clinician takes a position of active curiosity and interest in your inner life as well as in imagining with you about the inner life of your child. While there is empathic validation, there is respectful, active curiosity when your therapist might not be able to follow your thinking. It was unclear to your clinician, based on the description that you gave, that your child was being disrespectful toward you. Exploration and a genuine desire to understand how you reached that conclusion helps stimulate your own curiosity and openness to exploring other possible explanations for what may have been going on in your child’s mind. As shown above, in MBT, your clinician doesn’t offer interpretations of your behavior or suggestions on how to manage your behavior. Rather, your clinician supports you in flexibly maintaining mentalizing, which allows you to arrive at your own insights and change.